Dear Reader,
AS PROMISED, this month I will write about another one of the 12 most deadliest illnesses. Non-compliance is as dangerous as cancer or heart attacks. The term ‘non-compliance’ means “not following advice”; in this case, your doctor’s advice.
I have just returned from a conference in Porto where the latest news concerning metabolic illnesses, like diabetes, hypercholesterolaemia, hypertension and metabolic syndrome, was discussed. We now have a huge amount of data to support the fact that many of the most pressing health problems are, in fact, self-inflicted and lifestyle related.
It was impressive to see all this sophisticated research work put into Powerpoint presentations, but I could not help feeling that, despite all the available research, we are still not very successful when putting it into practice.
Non-compliance facts
• As many as one third of prescribed medication land in the bin because patients do not take it.
• Smoking has long been known as the most dangerous addiction, contributing to many health problems. However, doctors are not listened to and some don’t even listen to their own advice and smoke themselves.
• It is much easier to send a patient away happy, with a prescription in hand, than with a piece of paper giving him/her good, sound advice, without medication.
At this conference, I heard an interesting talk from a very experienced physician, which shed some light on why our patients often don’t listen to us. He explained that up to 85 per cent of the training of doctors takes place in hospitals, where they are trained to treat acute and severe illness. This is difficult in the beginning and takes up all our energy and time. Life in the real world, where most academic-teacher doctors have not worked, like in General Practice, is very different. The illnesses presented there are mostly chronic and long standing, and not the ones we have learnt to treat in hospital.
I, for example, sometimes read, with great amusement, the letters I wrote to general practitioners when I worked as a young doctor in a big teaching hospital. I can just see what my colleague must have thought about us teaching hospital doctors. They could see immediately that we had no idea what was going on in the real world.
What I am trying to say is that we need to add one extra subject to the training programme of doctors, and that is health coaching.
Health coaching means that you can actually make the knowledge you have, work in your team; in this case, the team is the patients.
Imagine that José Mourinho’s team only listens to 20 per cent of the advice he gives them. The team would play badly and he would not keep his job for very long. So what can we learn from Mourinho? He, somehow, manages to make his team do exactly what he has planned, and his plan is good.
The plan we doctors have is also quite good, but the problem is that we can’t persuade our patients to follow it. One of the reasons is that we do not try hard enough and that our emphasis is very much on giving information rather than being the health coach of our patients.
I often hear, at dinner parties, people speaking disappointedly about my profession because they are fed up of being bombarded with medication. More and more people turn to alternative healers like homeopaths, naturopaths and spiritual healers.
Patients of our complementary colleagues often don’t know exactly what they take, and why. However, the real reason why they feel better and respond better to the treatment, and that is mostly true in difficult and chronic illnesses, is because they feel listened to more.
In my opinion, we must integrate the subject, “the doctor as healer and health coach”, in the curriculum for medical schools. Modern medicine has powerful armaments, but many of them are not put into practice because we have not succeeded in convincing the patient that the treatment could be very useful for him/her.
Modern medicine should focus on becoming “speaking medicine”: medicine that explains and communicates with the patient so that they can really benefit from our knowledge.
I strongly believe that the doctor has to be a role model. It cannot work to go with the motto: “Don’t do what I do, but do what I say.” How can a patient succeed in quitting the unhealthiest of all habits – smoking – if he/she meets his/her own doctor with a pack of cigarettes in his shirt?
Last but not least, we should be seen a little bit like the coaches of football teams: they have to deliver results and so should we. On the curative side, we are not bad but it could be much better when it comes to preventing illnesses.
Yours,
Dr. Thomas Kaiser
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